Impact of metabolic risk factors on the severity and outcome of patients with alcohol-associated acute-on-chronic liver failure

Duseja A 1 , De A 1 , Taneja S 1 , Choudhury AK 2 , Devarbhavi H 3 , Hu J 4 Show all authors , Hamid SS 5 , Butt AS 5 , Jafri SMW 5 , Ghazinian H 6 , Chawla YK 1 , Dhiman RK 1 , Duan Z 7 , Chen Y 7 , Tan SS 8 , Lee GH 9 , Lim SG 10 , Kim DJ 11 , Sahu M 12 , Sollano JD 13 , Carpio G 14 , Mohan Prasad VG 15 , Abbas Z 16 , Lesmana LA 17 , Lesmana CR 17 , Eapen CE 18 , Goel A 18 , Sood A 19 , Midha V 19 , Goyal O 19 , Dokmeci AK 20 , Ning Q 21 , Chen T 21 , Ma K 21 , Payawal DA 22 , Lau GKK 23 , Al Mahtab M 24 , Rahman S 25 , Alam MS 25 , Shukla A 24 , Shrestha A 26 , Shah S 27 , Kalal CR 27 , Kumar G 28 , Jain P 28 , Paulson I 2 , Sarin SK 2 , APASL ACLF Working Party, APASL ACLF Research Consortium (AARC)

Affiliations 

  • 1 Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • 2 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
  • 3 Department of Gastroenterology, St John's Medical College Hospital, Bangalore, India
  • 4 Liver Failure Treatment and Research Center, 302 Military Hospital of China, Beijing, China
  • 5 The Aga Khan University, Karachi, Pakistan
  • 6 Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia
  • 7 Beijing Youan Hospital, Capital Medical University, Beijing, China
  • 8 Department of Hepatology, Selayang Hospital, Selangor, Malaysia
  • 9 Division of Gastroenterology and Hepatology, National University Health System, Singapore
  • 10 Medicine, Yong Loo Lin School of Medicine, Singapore
  • 11 Hallym University Medical Center, Seoul, Korea
  • 12 ISM and SUM Hospital, Bhubaneswar, India
  • 13 Medicine, Santo Tomas, Manila, Philippines
  • 14 University of Santo Tomas, Manila, Philippines
  • 15 VGM Hospital, Coimbatore, India
  • 16 Department of Hepatogastroenterology, Ziauddin University, Karachi, Pakistan
  • 17 Medicine, Medistra Hospital, South Jakarta, Indonesia
  • 18 Christian Medical College, Vellore, India
  • 19 Dayanand Medical College and Hospital, Ludhiana, India
  • 20 Department of Gastroenterology, Ankara University, Ankara, Turkey
  • 21 Tongji Medical College, Wuhan, China
  • 22 Cardinal Santos Medical Center, San Juan, Philippines
  • 23 Humanity and Health Medical Centre, Hong Kong
  • 24 Seth GS Medical College & Kem Hospital, Mumbai, India
  • 25 Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • 26 Foundation Nepal Sitapaila Height, Kathmandu, Nepal
  • 27 Hepatology, Global Hospital, Mumbai, India
  • 28 Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India
Liver Int, 2021 01;41(1):150-157.
PMID: 32970356 DOI: 10.1111/liv.14671

Abstract

BACKGROUND: Metabolic risk factors may impact the severity and outcome of alcoholic liver disease. The present study evaluated this effect in patients with alcohol-associated acute-on-chronic liver failure (ACLF).

METHODOLOGY: One thousand two hundred and sixteen prospectively enrolled patients with ACLF (males 98%, mean age 42.5 ± 9.4 years, mean CTP, MELD and AARC scores of 12 ± 1.4, 29.7 ± 7 and 9.8 ± 2 respectively) from the Asian Pacific Association for the Study of the Liver (APASL) ACLF Research Consortium (AARC) database were analysed retrospectively. Patients with or without metabolic risk factors were compared for severity (CTP, MELD, AARC scores) and day 30 and 90 mortality. Information on overweight/obesity, type 2 diabetes mellitus (T2DM), hypertension and dyslipidaemia were available in 1028 (85%), 1019 (84%), 1017 (84%) and 965 (79%) patients respectively.

RESULTS: Overall, 392 (32%) patients died at day 30 and 528 (43%) at day 90. Overweight/obesity, T2DM, hypertension and dyslipidaemia were present in 154 (15%), 142 (14%), 66 (7%) and 141 (15%) patients, respectively, with no risk factors in 809 (67%) patients. Patients with overweight/obesity had higher MELD scores (30.6 ± 7.1 vs 29.2 ± 6.9, P = .007) and those with dyslipidaemia had higher AARC scores (10.4 ± 1.2 vs 9.8 ± 2, P = .014). Overweight/obesity was associated with increased day 30 mortality (HR 1.54, 95% CI 1.06-2.24, P = .023). None of other metabolic risk factors, alone or in combination, had any impact on disease severity or mortality. On multivariate analysis, overweight or obesity was significantly associated with 30-day mortality (aHR 1.91, 95% CI 1.41-2.59, P 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications